Mathys L, Harder Y, Furrer M
Departement Chirurgie, Rätisches Kantonsspital, Chur, Schweiz.
Chirurg. 2003 Dec;74(12):1128-33. doi: 10.1007/s00104-003-0710-y.
The management of patients suffering from abdominal aortic aneurysms with concomitant intestinal disease is demanding. Surgical procedures have to be evaluated meticulously with regard to morbidity and priority. We retrospectively investigated early and late results of nine patients (eight males, one female) with coincidental aortic and intestinal surgery during the last 9.5 years. The average age was 77 years (range 67-85). One-stage procedures were undertaken twice with implantation of aortic grafts to replace abdominal aortic aneurysms (AAA). During these emergency procedures, an aortoduodenal fistula was repaired in one case and resection of an ischemic segment of the sigmoid colon was resected in another. Seven two-stage procedures were performed as elective surgery. Five AAA were excluded before the intestinal repair. In two cases of urgent visceral pathologies, colon resection was done first, followed by elimination of the AAA. In case of elective surgery, two-stage procedures seem to be safe and effective. However, in certain emergent cases, one-stage procedures with implantation of vascular grafts in combination with colon or bowel surgery might also be justified.
腹主动脉瘤合并肠道疾病患者的管理颇具挑战性。必须从发病率和优先级方面对手术程序进行细致评估。我们回顾性研究了过去9.5年中9例（8例男性，1例女性）同时进行主动脉和肠道手术患者的早期和晚期结果。平均年龄为77岁（范围67 - 85岁）。有两次进行了一期手术，植入主动脉移植物以替换腹主动脉瘤（AAA）。在这些急诊手术中，1例修复了主动脉十二指肠瘘，另1例切除了乙状结肠的缺血段。7例进行了二期手术作为择期手术。在肠道修复前排除了5例AAA。在2例紧急内脏病变中，先进行了结肠切除，随后消除了AAA。对于择期手术，二期手术似乎安全有效。然而，在某些紧急情况下，植入血管移植物的一期手术联合结肠或肠道手术也可能是合理的。
